eye inflammatory disorders Flashcards
inflammation of any component of the uveal tract
iris (anterior) –> most cases
ciliary body (intermediate)
choroid (posterior)
uveitis
uveitis is also called
iritis
most uveitis is
anterior
uveitis caused by
trauma, inflammation, or infection
how do patients present with uveitis
vision changes
if uveitis is anterior patients present with
eye pain, redness, tearing, and photophobia
iritis –> inflammation is limited to iris
iridocyclitis –> inflammation is of iris and ciliary body
anterior uveitis
choroiditis
chorioretenitis
posterior uveitis
what should you do with all patients with uveitis
referred to ophthalmologist
how many % of cases of uveitis is anterior
73%
MC age for uveitis
25-64
in children, what is the most common associated systemic disease with uveitis
juvenile rheumatoid arthritis
common cause of iritis
trauma
less common infections of iritis
herpes
syphilis
TB
unilateral eye pain, redness, tearing, photophobia, decreased vision
360-degree perilimbal injection, most
history of eye trauma, an associated systemic disease, or risk factors for infection
anterior acute uveitis
severe anterior uveitis may cause a ___________ from layering of leukocytes and fibrous debris in the anterior chamber
hypopyon
presents with altered vision or floaters
often there is no pain, redness, tearing, or photophobia
intermediate and posterior uveitis diagnosis
panuveitis
gradual and usually a bilateral onset
few vision complaints unless cataracts or glaucoma develop
sarcoid uveitis diagnosis
anterior uveitis is unilateral and sarcoid uveitis is typically bilateral
typical distribution diagnosis
what to do in uveitis if cause not readily apparent
lab testing
CBC, BMP, UA, ESR
what to consider for patients with recurrent anterior uveitis
HLA-B27
what to do for syphilis uveitis
serology
uveitis treatment
refer patients for any red eye along with loss of vision to an ophthalmologist
dilated fundoscopy for other ocular trauma
measurement of intraocular pressure
treatment– steroid and/or cycloplegics for comfort
traumatic uveitis
slit lamp exam and lab tests to assist with diagnosis of underlying cause
treatment- based on underlying cause but usually topical steroid drops with or without cycloplegia
non traumatic uveitis
inflammations of the the deeper layers of the eye, the vascular episclera, and the avascular episclera
episcleritis and scleritis
segmental eye redness
discomfort but not severe pain
no vision loss
episcleritis
may have overlying episcleritis
violaceous hue to sclera*
painful
may cause vision loss
scleritis (EMERGENCY)
scleritis and episcleritis more common in
women
scleritis median age at diagnosis
56
episcleritis median age at diagnosis
45
scleritis and episcleritis often associated with
systemic illness
connective tissue or vasculitic disease
scleritis often occurs with
episcleritis
episcleritis does not involve the _______ and does not progress to ________
sclera; scleritis
causes of scleritis
systemic autoimmune diseases (RA, wegener granulomatosis)
infections (pseudomonas, TB, syphillis, herpes zoster)
idiopathic
causes of episcleritis
idiopathic
does episcleritis disrupt vascular architecture and cause vision loss
no, scleritis does
segmental or diffuse inflammation of sclera (violaceous, purple, blue) with overlaying episcleral and conjunctival inflammation
severe, boring eye pain often radiating to head and neck that worsens with eye movement
20% of patients may not have pain
photophobia and vision loss
scleritis
why must scleritis be differentiated from episcleritis
scleritis requires treatment and an evaluation for underlying medical conditions
segmental or diffuse inflammation of episclera (pink color) and overlying conjunctival vessel injection
mild if any discomfort but can be tender to palpation
no vision disturbance
episcleritis
what blanches inflamed episcleral and conjunctival vessels, but not scleral vessels
10% phenylephrine
when to do labs and imaging for scleritis
if associated systemic disease has not been previously diagnosed
imaging for scleritis
chest x ray, sinus CT, SI joint x ray
labs for scleritis
CBC, metabolic panel, UA, ANCA
what imaging for posterior scleritis
ophthalmic ultrasound or orbital CT
scleritis management
refer to opthalmologist immediately!
initial: systemic NSAIDS and/or topical steroids
if no response to above: systemic steroids, subconjunctival steroids, or immune modulators
episcleritis management
often resolves spontaneously
eye redness and irritation improve by 50% in less than 1 week
redness and discomfort may improve with topical NSAIDS or artificial tears
